Diagnostic Performance of Novel Troponin Algorithms for the Rule-Out of Non-ST-Elevation Acute Coronary Syndrome.
BACKGROUND: The European Society of Cardiology (ESC) rule-out algorithms use cutoffs optimized for exclusion of non-ST elevation myocardial infarction (NSTEMI). We investigated these and several novel algorithms for the rule-out of non-ST elevation acute coronary syndrome (NSTE-ACS) including less u...
| Published in: | Clinical Chemistry Vol. 68; no. 2; pp. 291 - 303 |
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| Main Authors: | , , , , , , , , , , |
| Format: | research tables/charts Journal Article |
| Published: |
Oxford University Press / USA
Feb2022
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=155166548&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 155166548 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00099147 10CS jtl: Clinical Chemistry issn: 00099147 maglogo: N pubinfo: dt: Feb2022 vid: 68 iid: 2 pid: 622 pub: Oxford University Press / USA artinfo: ui: 155166548 155166548 155166548 10.1093/clinchem/hvab225 155166548 ppf: 291 ppct: 12 formats: fmt: @attributes: type: P tig: atl: Diagnostic Performance of Novel Troponin Algorithms for the Rule-Out of Non-ST-Elevation Acute Coronary Syndrome. aug: au: Tjora, Hilde L. Steiro, Ole-Thomas Langørgen, Jørund Bjørneklett, Rune O. Skadberg, Øyvind Bonarjee, Vernon V. S. Mjelva, Øistein R. Collinson, Paul Omland, Torbjørn Vikenes, Kjell Aakre, Kristin M. affil: Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway sug: subj: Non-ST Elevated Myocardial Infarction Diagnosis Acute Coronary Syndrome Diagnosis Troponin Diagnostic Use Algorithms Human Male Female Middle Age Aged Aged, 80 and Over Cross Sectional Studies Prospective Studies Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over Male Female ab: BACKGROUND: The European Society of Cardiology (ESC) rule-out algorithms use cutoffs optimized for exclusion of non-ST elevation myocardial infarction (NSTEMI). We investigated these and several novel algorithms for the rule-out of non-ST elevation acute coronary syndrome (NSTE-ACS) including less urgent coronary ischemia. METHOD: A total of 1504 unselected patients with suspected NSTE-ACS were included and divided into a derivation cohort (n=988) and validation cohort (n=516). The primary endpoint was the diagnostic performance to rule-out NSTEMI and unstable angina pectoris during index hospitalization. The secondary endpoint was combined MI, all-cause mortality (within 30 days) and urgent (24 h) revascularization. The ESC algorithms for high-sensitivity cardiac troponin T (hscTnT) and I (hs-cTnI) were compared to different novel low-baseline (limit of detection), low-delta (based on the assay analytical and biological variation), and 0-1-h and 0-3-h algorithms. RESULTS: The prevalence of NSTE-ACS was 24.8%, 60.0% had noncardiac chest pain, and 15.2% other diseases. The 0-1/0-3-h algorithms had superior clinical sensitivity for the primary endpoint compared to the ESC algorithm (validation cohort); hs-cTnT: 95% vs 63%, and hs-cTnI: 87% vs 64%, respectively. Regarding the secondary endpoint, the algorithms had similar clinical sensitivity (100% vs 94%-96%) but lower clinical specificity (41%-19%) compared to the ESC algorithms (77%-74%). The rule-out rates decreased by a factor of 2-4. CONCLUSION: Low concentration/low-delta troponin algorithms improve the clinical sensitivity for a combined endpoint of NSTEMI and unstable angina pectoris, with the cost of a substantial reduction in total rule-out rate. There was no clear benefit compared to ESC for diagnosing high-risk events. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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